Provider Demographics
NPI:1104999804
Name:REINHARDT, PAMELA SUZANNE (LMP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUZANNE
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:SUZANNE
Other - Last Name:REINHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:4110 80TH ST E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98443-1051
Mailing Address - Country:US
Mailing Address - Phone:253-548-8819
Mailing Address - Fax:253-472-5272
Practice Address - Street 1:8002 PORTLAND AVE E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-3330
Practice Address - Country:US
Practice Address - Phone:253-472-5272
Practice Address - Fax:253-472-5272
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006049225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist